| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
436 |
219 |
$312K |
| D1110 |
Prophylaxis - adult |
1,048 |
1,045 |
$53K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
454 |
235 |
$51K |
| D2950 |
|
284 |
165 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
1,151 |
1,147 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
544 |
541 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
850 |
831 |
$13K |
| D0274 |
Bitewings - four radiographic images |
391 |
391 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
139 |
85 |
$12K |
| D1120 |
Prophylaxis - child |
287 |
287 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
157 |
153 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
594 |
567 |
$5K |
| D1206 |
Topical application of fluoride varnish |
193 |
193 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
201 |
200 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
37 |
37 |
$2K |
| D0330 |
Panoramic radiographic image |
15 |
14 |
$890.18 |
| D0801 |
|
12 |
12 |
$0.00 |